Ventolin Evohaler Precautions : The management of asthma should normally follow a stepwise programme, and response should be monitored clinically and by lung function tests.Increasing use of short-acting inhaled ?2-agonists to control symptoms indicates deterioration of asthma control. Under these conditions, the patient's therapy plan should be reassessed.Sudden and progressive deterioration in asthma control is potentially life-threatening and consideration should be given to starting or increasing corticosteroid therapy.If dose fails to give usual relief, medical advice should be sought.Use with caution in patients with thyrotoxicosis.In common with other ?-adrenoceptor agonists, Ventolin can induce reversible metabolic changes, eg reversible hypokalaemia and increased blood sugar levels. Concurrent administration of corticosteroids can exaggerate this effect.Potentially serious hypokalaemia may result from ?2-agonist therapy mainly from parenteral and nebulised administration. Particular caution is advised in acute severe asthma as this effect may be potentiated by concomitant treatment with xanthine derivatives, steroids, diuretics and by hypoxia. It is recommended that serum potassium levels are monitored in such situations.Expectorant Syrup: Long-term treatment with Ventolin expectorant (sugar-containing preparation) increases the risk of dental caries. It is important that adequate dental hygiene is maintained.Respirator Solution/Nebules: Caution in patients who have received large doses of other sympathomimetic drugs.Acute angle-closure glaucoma with a combination of nebulised salbutamol and ipratropium bromide. A combination of nebulised salbutamol with nebulised anticholinergics should therefore be used cautiously. Patients should be warned not to let the solution or mist enter the eye.Patients receiving treatment at home with Ventolin respirator solution must be warned that if either the usual relief is diminished or the usual duration of action reduced, they should not increase the dose or its frequency of administration, but should seek medical advice.Respirator Solution: Reversible metabolic changes, eg increased blood glucose.Evohaler: In patients considered at risk, daily peak flow monitoring may be instituted.In the event of a previously effective dose of inhaled salbutamol failing to give relief for at least 3 hrs, seek medical advice.Patients' inhaler technique should be checked to make sure that aerosol actuation is synchronised with inspiration of breath for optimum delivery of the drug to the lungs.Nebules: In domiciliary use, if dose fails to give usual relief, medical advice should be sought.Injection: The use of Ventolin parenteral preparations in the treatment of severe bronchospasm or status asthmaticus does not obviate the requirement for glucocorticoid steroid therapy as appropriate. When practicable, administration of oxygen concurrently with parenteral Ventolin is recommended, particularly when it is given by IV infusion in hypoxic patients.Diabetic patients and those currently receiving corticosteroids should be monitored frequently during IV infusion of Ventolin. For these patients, Ventolin injection should be diluted with sodium chloride injection BP, rather than sodium chloride and dextrose injection BP.In the treatment of premature labour by IV infusion of salbutamol increases in maternal heart rate of the order of 20-50 beats/min usually accompany the infusion. The maternal pulse rate should be monitored and not normally allowed to exceed a steady rate of 140 beats/min. Maternal blood pressure may fall slightly during the infusion; the effect being greater on diastolic than on systolic pressure. Falls in diastolic pressure are usually within the range of 10-20 mm Hg. The effect of infusion on foetal heart rate is less marked but increases of up to 20 beats/min may occur. In the treatment of premature labour, before Ventolin parenteral preparations are given to any patient with known heart disease, an adequate assessment of the patient's cardiovascular status should be made by a physician experienced in cardiology.Tablet/Injection: As maternal pulmonary oedema has been reported during or following treatment of premature labour with ?2-agonists, careful attention should be given to fluid balance and cardiorespiratory function monitored.Use in pregnancy & lactation: As with any medicine, administration of drugs during pregnancy should only be considered if the expected benefit to the mother is greater than any possible risk to the foetus.During worldwide marketing experience, rare cases of various congenital anomalies, including cleft palate and limb defects have been reported in the offspring of patients being treated with salbutamol. Some of the mothers were taking multiple medications during their pregnancies.Because no consistent pattern of defects can be discerned, and baseline rate for congenital anomalies is 2-3%, a relationship with salbutamol use cannot be established.As salbutamol is probably secreted in breast milk, its use in nursing mothers is not recommended unless the expected benefits outweigh any potential risk. It is not known whether salbutamol in breast milk has a harmful effect on the neonate. .